Basic Information
| Provider Information | |||||||||
| NPI: | 1457643801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PFANNENSTIEL | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 GRUENE HVN | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781323368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079913775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 221 3RD ST W BLDG 1040 | ||||||||
| Address2: | |||||||||
| City: | JBSA RANDOLPH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781504800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109169900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 56587 | TX | N | Pharmacy Service Providers | Pharmacist | 183500000X | PR5414 | ME | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 1457643801 | 05 | ME | MEDICAID |